Volume 24, Issue 3 (July 1979)
Fatal Retropleural Hematoma from a Ruptured Abdominal Aortic Pseudo-Aneurysm
Farmley et al  reported that five patients, or 38% of the 13 cases studied, who had primary penetrating wounds of the aorta caused by missiles and stabbing and who survived the immediate posttraumatic period, developed a false aneurysm which ultimately ruptured. In the absence of a pathologic tract leading away from the retroperitoneal space and peritoneal cavity, any rupture of the abdominal aorta will result in accumulation of blood in the retroperitoneal space or peritoneal cavity, or both. After a thorough search of the literature the author concludes that the case reported here appears to be the only case of retropleural hematoma where the source of the bleeding is the abdominal aorta. Further, this is the only case of a traumatic abdominal aortic pseudo-aneurysm spontaneously rupturing into the retropleural space in the absence of a pathologic tract connecting the retropleural and retroperitoneal and peritoneal spaces without hemorrhage in the latter two spaces. Correct radiographic interpretation of the chest films in the early stages of the development of retropleural hemorrhage can be made by noting the effacement of aortic shadow and the left primary sulcus by a convex homogenous density in the posterior mediastinum and by correlating these results with the clinical presentation.